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Paeds MH – Physical activity can improve body image for children and adolescents

Evidence Summary
Nine studies considered the association between body image and physical activity.
· A majority of the studies suggested that higher levels of physical activity led to better body image in their participants (1), especially in adolescent males (3,7).
· AN RCT of 110 non physically active adolescent girls showed an increase in self-perception and social anxiety scores after a 6-month exercise intervention programme (9)
· A meta-analysis including 114 articles, 4 of which were RCTs demonstrated significant positive associations between physical activity and self-image (8)
· Body image should not be the main driver to perform exercise as this has an association with an increase in self harm (2). A careful approach should be undertaken when suggesting exercise in children with body image concerns, since this may risk potentiating pre-existing body dysmorphia in this vulnerable population.
· A large evaluation of 5453 students showed there was no association with the intensity of physical activity and body image, suggesting even moderate levels of physical activity would have a positive association with body image (4)

Quality of Evidence
B. Mix of study designs contribute to the evidence, which includes meta-analysis, RCTs and longitudinal with cross-sectional analysis.
Strength of Recommendation
1 Strong recommendation, from a range of robust study designs including meta-analysis, RCTs, longitudinal studies
There is a strong recommendation from moderate evidence that participation in physical activity can improve body image. Although it should not be the focus on why children and adolescents take part in physical activity as this can have negative effects.


  1. Asare M, Danquah SA. The relationship between physical activity, sedentary behaviour and mental health in Ghanaian adolescents. Child and adolescent psychiatry and mental health. 2015 Dec;9(1):11.
  2. Boone SD, Brausch AM. Physical Activity, Exercise Motivations, Depression, and Nonsuicidal Self‐Injury in Youth. Suicide and Life‐Threatening Behavior. 2016 Oct;46(5):625-33.
  3. Altıntaş A, Aşçı FH, Kin-İşler A, Güven-Karahan B, Kelecek S, Özkan A, Yılmaz A, Kara FM. The role of physical activity, body mass index and maturity status in body-related perceptions and self-esteem of adolescents. Annals of human biology. 2014 Sep 1;41(5):395-402.
  4. Tao FB, Xu ML, Kim SD, Sun Y, Su PY, Huang K. Physical activity might not be the protective factor for health risk behaviours and psychopathological symptoms in adolescents. Journal of paediatrics and child health. 2007 Nov;43(11):762-7.
  5. Niven A, Fawkner S, Knowles AM, Henretty J, Stephenson C. Social physique anxiety and physical activity in early adolescent girls: the influence of maturation and physical activity motives. Journal of Sports Sciences. 2009 Feb 1;27(3):299-305.
  6. Greenleaf CA, Petrie TA, Martin SB. Psychosocial variables associated with body composition and cardiorespiratory fitness in middle school students. Research quarterly for exercise and sport. 2010 Sep 1;81(sup3):S65-74.
  7. Goldfield GS, Henderson K, Buchholz A, Obeid N, Nguyen H, Flament MF. Physical activity and psychological adjustment in adolescents. Journal of Physical Activity and Health. 2011 Feb 1;8(2):157-63.
  8. Rodriguez-Ayllon M, Cadenas-Sanchez C, Estévez-López F, Muñoz NE, Mora-Gonzalez J, Migueles JH, Molina-García P, Henriksson H, Mena-Molina A, Martinez-Vizcaino V, Catena A. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports medicine. 2019 Apr 16:1-28.
  9. Lindwall M, Lindgren EC. The effects of a 6-month exercise intervention programme on physical self-perceptions and social physique anxiety in non-physically active adolescent Swedish girls. Psychology of Sport and Exercise. 2005 Nov 1;6(6):643-58.